Managing Spasticity

The care managers at AdvancedRM are no strangers to advocating for those who have suffered brain trauma or injuries to the spinal cord. Just read our case studies about Matthew and Jack. We remain committed to educating ourselves to the fullest extent regarding the ordeals these young men endured. In doing so, we have become experts in the phenomenon of spasticity.

Spasticity is…

Spasticity is a significant concern among those who have suffered severe brain injuries (TBI) or spinal cord injuries (SCI). It manifests as irregular and involuntary behavior within the muscles.

• Spasticity is a “spasm” or tightening of a muscle or muscles, rendering them stiff, overactive, and difficult to move.
• Spasticity is erratic, sometimes worse at night and interfering with sleep or sometimes worse during certain activities, particularly when the muscles are stressed.
• Spasticity may be treatable; mostly by controlling the triggers, taking prescribed medicine, and working with a trained therapist who understands the mechanisms causing the spasticity.

Before you can fully understand spasticity, you need to understand how muscles work. With muscle contraction comes muscle weakness, since the muscles are unable to stretch or relax. With muscle weakness, loss of fine motor control, and overactive reflexes may follow.

How do muscles work?

Muscles work through a system of contracting and relaxing, triggered by nerves sent through the spinal cord via the brain. Once that neural pathway is disrupted, numerous problems arise; one of which may be unwanted muscle contractions. In order to understand its treatment, it helps to visualize how muscles actually work.

No movement is caused by a lone muscle. There are antagonist muscles and there are agonist muscles. Treatment of one but not the other will only exacerbate the situation. There is a push and pull to muscle function, which must be addressed when treating a spastic muscle.

What triggers spasticity?

Spasticity sometimes “comes out of nowhere”, or at least may seem like that. In other people, it is persistent at all times. In all cases, there triggers which make it worse. Spasticity tends to occur when you:

• Stretch or move an arm or a leg
• Are involved in activities requiring a lot of exertion
• Have a urinary tract infection, full bladder, or other illness
• Have constipation or large hemorrhoids
• Have an injury to the muscles, tendons, or bones (including bone fractures)
• Wear tight clothing or wraps
• Feel emotional stress
• Participate in excessive activity or are fatigued

If any one of these triggers occur, any number of symptoms may emerge.

What are the symptoms of spasticity?

Spasticity and its symptoms are too easily underestimated. The reason is because spasticity is not always a constant threat. It can be dormant and not require treatment at all. Part of our goal in researching this condition has been to be acutely aware of the problems it causes. We share in our clients’ relief when it isn’t an issue but feel it is our job to remain vigilant on their behalf. A comprehensive list of spasticity symptoms we have unearthed ranges from the obvious to the insidious:

• Pain from the tightening of muscles
• Limited range of motion
• Difficulty breathing
• Falls
• Restrictions with normal activities such as feeding or grooming
• Difficulty walking, sitting, and moving in bed
• Challenges for the caregiver in all activities of daily living
• Contractures

What do we do about spasticity?

Our end purpose as care managers is to use what we have learned to communicate with and assist healthcare professionals on behalf of our clients. So, at the end of our research, we arrived at what we feel are the most effective responses to spasticity:

• Therapeutic interventions such as physical therapy, occupational therapy, hypnotherapy and aquatics
• Physical modalities such as ultrasonography, electrical stimulation and biofeedback
• Relaxation techniques for reducing stress and tone
• Taping, dynamic and static splints, wheelchairs, and standers for maintaining range of motion
• Oral medications
• Injectable medications such as Botox and other muscle relaxants
• Surgery

Feel free to browse our blog posts. You will see firsthand how enthusiastic we can be when it comes to writing about solutions. We are always quick to notice technology that strikes us as tools of our trade. Advocating for TBI and SCI patients is intensive work. Spasticity is merely one complication that arises. We would be more than happy to discuss the matter further.